Provider Demographics
NPI:1407884455
Name:NEW YORK PAIN MANAGEMENT PLLC
Entity Type:Organization
Organization Name:NEW YORK PAIN MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-371-0777
Mailing Address - Street 1:9 OLD PLANK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3107
Mailing Address - Country:US
Mailing Address - Phone:518-283-5418
Mailing Address - Fax:518-283-5421
Practice Address - Street 1:9 OLD PLANK RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3107
Practice Address - Country:US
Practice Address - Phone:518-371-0777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDA3878Medicare PIN
NYAA1535Medicare PIN
NYA191535Medicare ID - Type Unspecified